Provider Demographics
NPI:1457862708
Name:BETTY JEAN KERR PEOPLES HEALTH CENTERS
Entity Type:Organization
Organization Name:BETTY JEAN KERR PEOPLES HEALTH CENTERS
Other - Org Name:PEOPLE'S HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-367-7848
Mailing Address - Street 1:5701 DELMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-2617
Mailing Address - Country:US
Mailing Address - Phone:314-367-7848
Mailing Address - Fax:314-367-2985
Practice Address - Street 1:49 N FLORISSANT RD STE 101
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135-2312
Practice Address - Country:US
Practice Address - Phone:314-633-8921
Practice Address - Fax:314-524-9227
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETTY JEAN KERR PEOPLES HEALTH CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-13
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MON00015533261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500048820Medicaid